乙肝病毒携带产妇感染状态与胎儿宫内感染的相关性研究

Study on the correlation between infection status of hepatitis B virus puerpera carriers and intrauterine infection of the fetal

【目的】探究乙肝病毒携带产妇感染状态与新生儿母婴传播的相关性。【方法】将115例乙肝表面抗原为阳性的产妇分为4组,对四组产妇的血清、乳汁以及唾液进行乙肝表面抗原(HBs Ag)、乙肝表面抗体(HBs Ab)、乙肝e抗原(HBe Ag)、乙肝e抗体(HBe Ab)、乙肝核心抗体(HBc Ab)和HBV的病毒载量检测,并对婴儿在出生后的1 d内进行血液HBs Ag、HBs Ab、HBe Ag、HBe Ab、HBc Ab的检测。【结果】大三阳和小三阳产妇乳汁的检测结果相比较,大三阳所含有的乙肝病毒更高(P<0.05),但是在唾液当中并没有特异性差异。大三阳和小三阳产妇血液的检测结果相比较,大三阳HBV的病毒载量更高,实验显示,大三阳产妇的婴儿宫内感染率为14.3%。【结论】产后应使用联合免疫的手段,以减少新生儿乙肝的感染几率。大三阳及HBV的病毒含量较高的产妇需要谨慎喂养,小三阳患者哺乳时需要检验HBV的病毒载量,防止乳汁对新生儿的感染。

[Objective]To explore the correlation between the infection status of hepatitis B virus puerpera carriers and neonatal moth- er-to-child transmission （MTCT）. [ Methods ] One hundred and fifteen pregnant women with positive hepatitis B surface antigen were divided into four groups. The contents of HBsAg, HBsAb, HBeAg, HBeAb, HBcAb and the viral load of hepatitis B virus in serum, breast milk and saliva were detected. The blood levels of HBsAg, HBsAb, HBeAg, HBeAb, HBcAb in the neonates were determined within 1 day after the birth. [Results] According to the results of breast milk detection in pregnant women with HHA（HbsAg, HbeAg, and Anti-HBc positive） and HAA（HbsAg, Anti-Hbe, and Anti-HBc positive）, hepatitis B virus level in patients with HHA was higher （P〈0.05）, but those in saliva showed no statistical difference. As for the results of blood detection in patients with HHA and HAA, viral load of hepatitis B virus in pregnant women with HHA was much higher. In the experiment, neonatal intrauterine infection rate in preg- nant women with HHA was 14.3%. [ Conclusion ] Postpartum combined immunization should be applied in order to reduce the risk of neonatal infection of hepatitis B. Pregnant women with HHA or high content of hepatitis B virus need careful feeding, while viral load of hepatitis B virus in patients with HAA should be detected during lactation to prevent breast milk infection for the newborn.